EPIDEMIOLOGY OF ACUTE DIARRHEAL DISEASES IN CHILDREN IN A HIGH STANDARD-OF-LIVING RURAL SETTLEMENT IN ISRAEL

Epidemiologic patterns of acute diarrheal diseases in a high standard of living communal settlement, situated in a region endemic for enteric diseases, were evaluated by a historical prospective study of 284 children (12 064 child months) from August, 1988, through July, 1992. Three hundred eighty-three episodes of acute diarrhea were identified, yielding a rate of 0.38 episode per 12 child months. One hundred and children (35.6%) were reported to have 1 to 4 diarrheal episodes and 29 (10.2%) children had 5 or more diarrheal episodes during the follow-up period. The mean number of episodes of acute diarrhea per 12 child months in children ages 0 to 2 years was 2.28, in 2- to 6-year-olds 0.44, in 6- to 13-year-olds 0.12 and in 13- to 18-year-olds 0.03 (P < 0.001). Children less than 12 months of age had a lower incidence of acute diarrheal diseases during the months they were being breast-fed than children that were fed with formula during the same period (1.22 vs. 3.06 episodes per 12 child months, respectively; P < 0.001). Enteropathogens were isolated in 40% of diarrheal episodes in which stool cultures were obtained. The identification rates of the various enteropathogens were: diarrheagenic Escherichia coli, 11%; Shigella spp., 10%; Giardia lamblia, 10%; Salmonella spp., 4%; Staphylococcus aureus, 3%; Campylobacter jejuni, 1%. Potential interventions against acute diarrhea in this set up of a high standard of living rural community are education of caretakers and parents on hygienic practices that can prevent transmission of pathogens among the young children and encouraging mothers to breast-feed their children.